Overview and Objectives

Who are the families? What are the components of the

intervention? What is important to know, to do? What does it look like “on the ground”?

Getting to Know You

Who has provided services… To families with children exposed to

domestic violence? To women in violent relationships? That are manualized? That are skills-based? That are offered in families’ homes? That are empirically supported? That blend casework and mental health

services?

Beliefs and Values: Influence on Helping

Relationship What causes DV? Where does it come from? What should a woman do when it happens? Why do women stay in abusive relationships? What problems might DV cause for children? How does a perpetrator become a perpetrator?

How might beliefs and values that you hold influence how you help your clients?

How might they get in the way of being helpful? 

Examples

If we believe marriage is forever and divorce is wrong, it may be hard to see a marriage end, even when it’s due to DV.  

If we believe the only way to end DV is to end the relationship, it may be hard to help a victim who chooses to stay in the relationship.

Context: Our Beliefs and Values

Our relationships with families are the most powerful tools we have in our work. Engagement, Rapport, Caring 

We are humbled by the difficulties these families face and amazed by their resilience.

We are honored and grateful that they allow us to enter their lives – their homes – and get to know them.

They usually have good reasons for the choices they make, even if they are different than the choices we would make.

A tightly focused, skills-based intervention can bring about positive changes in the children’s and families’ lives.

Adjustment of children exposed to DV

25% – 70% have adjustment problemsMOST PREVALENT: Conduct Problems

Many have other adverse circumstances and risk factors

Ending their exposure to violence is an important goal, but it is seldom enough to resolve the

children’s problems

Barriers to Services

Most parents with IPV don’t seek mental health services for their children

1. Other important priorities Logistics barriers

o Schedulingo Child careo Time off from work

Safety

2. Don’t understand significance and potential outcomes of conduct problemso “It’s just a stage”o “She’ll grow out of it”o “Boys will be boys”

3. Some obtain services, buto Short durationo Inconsistent attendanceo Timing: crisis and priorities

What we’ve done to help

Project Support

■Empirically-based treatment designed to reduce conduct problems among children aged 4-9 exposed to frequent and severe domestic violence.

■Adapted to be sensitive to the varying circumstances (adversity package) of violent families

Key Points for Project Support

Priority: Engagement and Retention

Assistance with co-occurring problems and stressors Social support & instrumental support

Focus on child mental health outcomes Skills-based Improve quality of parent-child relationship Improve parental effectiveness

For whom is it appropriate?

Age of children (4-9) Help them early Help them before it’s too late

Other issues Significant parental substance

abuse or dependence Severe mental illness in mother or

child Neurological impairment of mother

or child Significant head injury Autism

Significant mental retardation in mother or child

Otherwise, any child who appears to need the services.

Project Support: What Comes First

Engage the families Have a conversation about their

view of the problems (esp. the children)

Describe the services Invite and answer questions Provide emotional support

If they are interested in services■ Assess to identify the children with

problems (interview, standardized measures)

■ Conduct family needs assessment

The family is interested, now what?

■ Continued focus on engagement Stay in touch, take time and listen

Offer assistance (assess needs) & follow up

Coordinate with other professionals

Don’t lose them!

No shows?

If you lose them, find them!

Continued engagement and relationship building

Let’s Get Started:Social and Instrumental Support

Structure Offer to come by, begin services Assess safety concerns Schedule first assessment and

treatment appointment

Begin services Weekly home visits Flexible schedule

A Note on Safety

1. Family safetyA. Always trust the woman’s sense of

danger

B. Some partners remain in the home

C. Mothers may include partners if they wish (and if therapist deems it safe)

D. Intervention is suitable for mothers and fathers It is NOT couples therapy

2. Staff safetyA. Teams and times

B. Neighborhoods

C. Signals

Relationship Style(Process)

■ Suspend judgment and preconceptions• Be open and curious• Invite and ask rather than instruct • Banish should, must, ought, need

■ Resistance?• Failure to engage• Failure to understand client perspective

■ Parenting skills are tailored to the child & family – not “cook-book” application

■ Model, model, model• Thinking aloud• Problem-solving (formal and informal)• Advocacy• Assess and re-assess• The skills• Affirm the positives

Social and Instrumental Support Content

Assessing the client’s problems What areas? How bad? What she has tried, what she thinks she

can do What kind of help would she need

Help with Resources Access to community resources

Advocate Transportation Fax, phone, internet

Problem-solving & decision-making skills Balance: Helping & professional role

Social Support (continued engagement) Stay in touch, follow up on problems,

successes, requests

Demonstrate that we care

Needs Assessment

Families will readily join with you if they believe:•That you understand their perspective on what’s important •That you have the potential to help

Shifting to the Children: Identifying Problems and

Strengths Find out from the client what the

problems are and what solutions she has tried.

You want:

Information about what she thinks are problems that her children have.

Some idea of her own sense of confidence and her approach to raising her children

To get enough information to have a pretty good idea of some of her strengths and how you might begin helping her with her problems.

Assessing Child Problems: Sample Questions

Sometimes when kids have seen a lot of violence, it’s hard for them...

1. How do you think it may have affected your children?

2. What things do they do that make you concerned, or angry, or worried?• Be very specifico When your child does this, what does it look like?o What does he/she say and do?o How often does this happen?o Are there certain things that seem to always make it

happen?

3. What things have you tried?• What do you say to him/her when this happens?• How does she/he respond?

4. What has worked well? Poorly?• Is there anything you’ve done that stopped it, even if

just for a little while?• Is there anything that has made it worse?

5. What are the things you feel best about in your children?

6. In your parenting?

Case 1: Engagement, social/instrumental support, child

problems 28, single, with 4 children

6 months 3 years (aggressive) 6 years 10 years (mentally ill)

Did not finish high school; does not have a GED

Has worked as a cook

Income is $600/month

Lives in a 1 bedroom apt.

Has no family, no car

Completely financially dependent on partner

The most important thing is to keep the family together and to “be a family.”

Children “don’t do what I say” “I can’t control my oldest” “We cannot go out in public”

Role PlayWith the person next to you (one be the client, one the therapist), you have the following goals:

1. Get to know the client/circumstances

2. Identify her concerns about her children’s adjustment

3. When you’re done, she should• Feel that you truly understand her situation

• Have a sense of hope that you can offer her real, tangible help

• Feel that her children and her relationship with them are a meaningful part of the discussion

Priorities: Engagement Many questions; few statements Assistance with co-occurring problems and

stressors• What has she tried and how has it worked?

• Provide social support & instrumental Support Assess child mental health Understanding from her perspective

Questions to Ask: Cheat Sheet

Sometimes when kids have seen a lot of violence, it’s hard for them...

1. How do you think it may have affected your children?

2. What things do they do that make you concerned, or angry, or worried?

• Be very specifico When your child does this, what does it look like?o What does he/she say and do?o How often does this happen?o Are there certain things that seem to always make it

happen?

3. What things have you tried?• What do you say to him/her when this happens?• How does she/he respond?

4. What has worked well? Poorly?• Is there anything you’ve done that stopped it, even if

just for a little while?• Is there anything that has made it worse?

5. What are the things you feel best about in your children?

6. In your parenting?

What worked well?

Client: Feeling understood A sense of hope and efficacy Your children, and your relationship with

them, are a meaningful part of the process

Therapist: What values or beliefs were you aware

of? What was difficult? What felt “right”? What felt “wrong” Did you feel you would be able to help

this family? How?

Either: Any feelings of judging or being judged?

Services that target children’s problems

II. Parenting and the Parent-Child Relationship

How hard can it be to improve a mother’s relationship with her

children?

Very hard

■ Conduct problems are challenging to the best of parents

■ Parenting components easy to understand, hard to learn to use

■ Few families come for agency mental health services consistently

■ 2-3 sessions typical

■ Parenting classes: “Been there, done that.”

Skills:Rationale & Sequencing

Key Points

Sequencing of skillsPositives/relationship enhancement first

Sometimes sufficient

Negatives/discipline strategies last

Always do them

Skills are cumulativeFocus on skill mastery at each step1.Assessment

2.Role plays

3.Homework and corrective action

4.Review

5.Repeat

“Dose” of treatmentAmount and allocation of session time

(this can be challenging)

Average number of sessions: 20

Questionable Assumptions

If you’re teaching mothers to parent differently, aren’t you implying that…

1. Mothers caused the problems? Other factors than parenting also contribute Adjustment is multiply determined

2. Mothers are not parenting properly? May be adequate for most children, but not

those with significant conduct problems Parenting gone awry: Coercive cycle

Mothers as change agents:

Mothers can help correct the problems regardless of their cause.

Skills-Based Approach

Evidence of effectiveness: Data

Overcoming barriers: Skills training can’t work if…1. The therapist doesn’t deliver it

Crises and life stressors sometimes make it challenging

2. If it’s not tailored to the specific child, parent, and circumstances

3. The mother doesn’t use itNot all clients respond the way we would like them to

Skills-Based Approach:Pros & Cons?

Choose where to spend your time1. May seem to contradict the methods some

are trained to use

2. However, therapists always make choices about what to intervene on and when; you can’t do everything, and you can’t do many things at the same time…pacing

May feel like “ignoring” underlying issues, not getting at the “root causes”1. Learning the skills opens up opportunities to

address these underlying issues.

2. Some think the root causes are changes in the parent-child relationship that have unfolded over time, ways the child has learned and internalized about how to think and respond in certain situations. If you address those you would be getting at the root causes

Staying on Task

■ Committed focus on skills and competence

■ Careful balance between mom/family and child issues

■ Tailoring the skills and approach to the specific family and child

■ Deliberate effort on getting through the skills

■ The skills don’t work identically for every child. Paying attention to when they don’t seem to be working is as important as paying attention to when they do.

How we do the skills part…

1. Introduce the skilla) What is it?

b) Why use it?c) Dos and don’ts

Assess and address mom’s understanding & comfort

2. Begin role play with mom (first time is hard)a) Therapist as mom, Mom as child

Assess mom’s understanding & comfortAffirm positives of mom’s role playing the child

b) Reverse roles and repeat

c) Assess mom’s understanding & comfortAffirm positives of mom’s role playTalk about weaknesses in positive termso Great at paying attention to the details of what she

was doing. You commented on how big the flower was and what a pretty red color she chose. Now we just need to work on getting a few more of those statements in to replace some of the questions.

d) When assured of success, role play between mom and child

A brief example: Case 2

Mid 30s, married, 5 children (4-22) Husband visits regularly, she’s not sure

what she wants from their relationship. Works as a hotel housekeeper Life is hard. She wants to protect her

children from being hurt by life. Criticizes them to teach them Doesn’t play with them They don’t show affection toward her Doesn’t give them things they haven’t

earned

First Skill: Attending

DEFINITION: NARRATING BEHAVIOR

1. What is it? Paying attention in a diferent way Learning to purposefully deploy attention Using attention to help teach the child what you

expect May not make immediate sense, but it will later as we

build on it

2. Why use it?

To help your child do more of the things you want to see, and less of what you don’t want to see.

3. What to do Allow the child to pick a fun task (coloring) Observe and describe what the child is doing Use intonation to convey enthusiasm (“sportscaster”) Be specific enough that someone listening from

another room would know what the child was doing

4. What not to do Don’t ask questions Don’t make suggestions Don’t teach

An “Attending” Role Play

Pair off again, but this time reverse roles, and this is what you do:

Introduce the skill (a limited example)

1. What it is & rationalea) Paying attention, but in a different way

b) Forms the basis of all the other skills

c) Idea is to narrate ( “sportscaster”, listener)

d) Child chooses activity

e) Mom can play only if invited and then only follows the child

f) Comment especially on things you want to see more of

2. Dos and don’ts

a) Follow the child’s lead

b) Use inflection and emotion in your voice

c) Don’t teach, instruct or ask – just comment

Now, you try it…

What worked?

Moms How was that? What felt “right”? Any discomfort? What about the practice?

Therapists Similarities and differences? Difficulties? What felt “right”? Any discomfort? What about the role play? If you did it again, how would you do it

differently?

Nuts and Bolts

1. Master’s Level Therapists trained in Skills-based parenting intervention Cognitive-behavioral (social learning)

principles Safety protocol

o For familieso For staffo Co-therapy training model

2. Small caseloads (2-3 cases) Intensive supervision (group) Home visits take time Work outside of sessions takes time Crises take time Burnout prevention and support

3. Child care – we bring our own! Child mentors (1-2) Undergraduates, for course credit Trained in child management skills NOT babysitters Take games, toys, crafts

If we don’t work hard to identify and help these children, who

will?

Persistence, perseverance, working hard to keep them! (may be different from traditional approaches)

■ Lots of effort to keep in touch and keep going

No shows

o Go to their house if needed

o Multiple phone calls

■ Keeping focused, working on the parenting and child problems even when mothers lose interest

Continued engagement, continuity of service staff (same therapist and mentor)

Mechanisms for tracking/locating families

Well-functioning relationships with collaborative partners – at all levels

Anything else?

Renee McDonald, Ph.D.Associate Professor of PsychologyCo-Director, Family Research CenterSouthern Methodist UniversityP.O. Box 750442Dallas, TX 75275-0442

Phone: 214-768-1128Email: rmcdonal@smu.edu

Ernest N. Jouriles, Ph.D.Professor of PsychologyCo-Director, Family Research CenterSouthern Methodist UniversityP.O. Box 750442Dallas, TX 75275-0442

Phone: 214-768-2360Email: ejourile@smu.edu

Contact Information